Background

pharmacy wall

During the last century, the principal function performed by community pharmacists changed from highly-valued extemporaneous compounding of medicines using profession-specific knowledge and techniques to the dispensing of mass produced standardised medicines in which the application of pharmacists' expertise is less apparent to patients or other health professionals.

The majority of dispensed medicines are now included on the Pharmaceutical Benefits Scheme [PBS] and a pharmacy business model heavily dependent on the PBS has emerged. Recent changes in dispensing remuneration have led to concern regarding the viability of a businesses model so heavily dependent on the supply function.

While there are issue of perception and of the viability of the existing model, the health system is changing in ways which create opportunities for pharmacists, particularly those in primary care. There is a growing and ageing population with a greater number of chronic medical conditions. People are being treated with an increasing range of new, more complex and expensive medicines. These changes create significant opportunities for pharmacists as patient-focused providers of medication-related healthcare.

In 1990 Hepler and Strand  introduced the philosophy of pharmaceutical care in which pharmacists focus on achieving definite health outcomes for their patients arising from the services they provide, rather than focus on the products that they dispense. This patient and outcome-focused approach aligns with developments in other health professions and has been incorporated in the vision statement endorsed by Australia's professional pharmacy organisations.

Models of professional practice

Numerous models of practice incorporating the philosophy of pharmaceutical care have been developed. Examples include smoking cessation, treatment of minor ailments, anti-coagulation monitoring services, diabetes prevention and management, immunization, cardiovascular health screening and chlamydia testing. In spite of the philosophy and models, the principle role of the majority of community pharmacists remains centered on the dispensing of products.

With few exceptions, patient-focussed professional services have yet to become a significant aspect of pharmacists' practice, deliver widespread patient benefits or have a major bearing on the viability of pharmacies. New pharmacy graduates report a disturbing mismatch between the opportunities they experience when they enter practice and their aspirations to practice pharmaceutical care incorporating the knowledge and skills that they acquired in their undergraduate education.

Future opportunities

Pharmacists have the need and opportunity to implement new models of practice which address demands within the health system, offer benefits to patients and provide challenging and rewarding career choices for both current practitioners and new graduates. Many of these models already exist however they have not been widely adopted.

It is hypothesized that there are a range of factors that form the framework within which pharmacists currently practice, that have a bearing on the sustained implementation of new models of practice. Project Pharmacist aims to foster understanding of the framework including consumer and stakeholder beliefs, legislation and policies, funding arrangements, information and technology systems, professional leadership, the capacity and capability of the pharmacist workforce and the expectations and attitudes of pharmacists themselves.